Reneging on residency match for Finance job

[WACC]

Title basically says it all.

I'm a MS IV at a US medical school with the good fortune of being in an existential crisis. I recently matched into a ROAD specialty. Am happy with the match as it is a decent place in a great location. I would be fine practicing the field as a career, and could probably become pretty good at it. At the same time, I stopped enjoying medicine after third year...hated the emphasis on rote memorization over problem solving, and capriciousness of other students, residents, and attending.

After medicine started waning, I started following and studying finance. I always had a yearning to do high finance, where the opportunity for creative problem solving is much higher, and recently got a job offer to work in health care private equity... Obviously these problems don't disappear in something as competitive as finance but the reward for dealing with them will be much higher if I'm successful...and that's the if. The way things stand now, my specialty, after residency, probably returns on average from 400-600k for life. PE, starts me at 250k, w/o residency, and it or similar career paths on Wall Street, return multiples of medicine if I'm successful.

Medical school has jaded me. I used to value the psychic reward from patient care significantly, now I wake up and just want to make it through the day. However, I'm still risk averse. if my goal is to optimize b/w maximizing payout and minimizing risk, is ROAD still worthwhile? I can't defer the job to do a year of internship.

My second issue is what I need to do now. if I do choose the PE job, I need to inform the PD of the transitional and advanced programs ASAP, but 1) how do I do this in the best way, 2) what are the consequences for future matches if I want to return to medicine, and 3) what steps can I take to hedge myself (I.e. take step 3, etc). I did well on boards but my grades were so-so.

Thanks in advance.

---

Members don't see this ad.

 

[Law2Doc]

Title basically says it all.

I'm a MS IV at a US medical school with the good fortune of being in an existential crisis. I recently matched into a ROAD specialty. Am happy with the match as it is a decent place in a great location. I would be fine practicing the field as a career, and could probably become pretty good at it. At the same time, I stopped enjoying medicine after third year...hated the emphasis on rote memorization over problem solving, and capriciousness of other students, residents, and attending.

After medicine started waning, I started following and studying finance. I always had a yearning to do high finance, where the opportunity for creative problem solving is much higher, and recently got a job offer to work in health care private equity... Obviously these problems don't disappear in something as competitive as finance but the reward for dealing with them will be much higher if I'm successful...and that's the if. The way things stand now, my specialty, after residency, probably returns on average from 400-600k for life. PE, starts me at 250k, w/o residency, and it or similar career paths on Wall Street, return multiples of medicine if I'm successful.

Medical school has jaded me. I used to value the psychic reward from patient care significantly, now I wake up and just want to make it through the day. However, I'm still risk averse. if my goal is to optimize b/w maximizing payout and minimizing risk, is ROAD still worthwhile? I can't defer the job to do a year of internship.

My second issue is what I need to do now. if I do choose the PE job, I need to inform the PD of the transitional and advanced programs ASAP, but 1) how do I do this in the best way, 2) what are the consequences for future matches if I want to return to medicine, and 3) what steps can I take to hedge myself (I.e. take step 3, etc). I did well on boards but my grades were so-so.

Thanks in advance.

First, if your goal is to "maximize payout and minimize risk" then it sounds like finance is a much Better fit for you. Medicine is not about this. The only ones who think this way are undergrads trying to talk themselves into a medical career. So too if you are focused on ultimate earnings. A lot is changing in medicine and I doubt you can speculate what the earnings are going to be in 3-5 years after residency, or even how plentiful jobs in your chosen career are going to be. But if you jump ship as a match violator, know that you are burning bridges. There are no good hedges if you don't complete at least intern year.

 

[WACC]

First, if your goal is to "maximize payout and minimize risk" then it sounds like finance is a much Better fit for you. Medicine is not about this. The only ones who think this way are undergrads trying to talk themselves into a medical career. So too if you are focused on ultimate earnings. A lot is changing in medicine and I doubt you can speculate what the earnings are going to be in 3-5 years after residency, or even how plentiful jobs in your chosen career are going to be. But if you jump ship as a match violator, know that you are burning bridges. There are no good hedges if you don't complete at least intern year.

Most of the better off practitioners Ive met think this way. Yes, medicine is changing, but ceterus paribus ROAD and specialties will in all likelihood continue paying multiples of the avg income in this country...unlike law, we bill a third party that sees health care as a right...which is why you switched "law2doc".

 

[mlw03]

You have to decide if it's worthwhile or not. But it sounds like you don't particularly want to be a doctor anymore, and are in the enviable position of being able to walk away and still make physician-level money. So do what you want, but know that if you leave medicine now you probably won't ever be able to return, ie there is no way to hedge your bet.

 

[Dr. USMLE]

I always had a yearning to do high finance, where the opportunity for creative problem solving is much higher, and recently got a job offer to work in health care private equity... Obviously these problems don't disappear in something as competitive as finance but the reward for dealing with them will be much higher if I'm successful...and that's the if. The way things stand now, my specialty, after residency, probably returns on average from 400-600k for life. PE, starts me at 250k, w/o residency, and it or similar career paths on Wall Street, return multiples of medicine if I'm successful.

I had a similar existential crisis, only earlier in med school, mainly due to the lack of emphasis on problem solving (as you mentioned). Ultimately, I decided ROAD was the better path. Let's do the math here...

Not sure which field you're talking about, but none of the ROAD specialties average 400-600k anymore, including rads (the most highly compensated on avg), and definitely will not for the rest of your life.

But for argument's sake, let's assume you average 600k for life. I'll assume you're going into rads and graduate fellowship at 31. 50k*6 years + 600k*34 year career = $20.7 M.

For PE, you start at 250k. So let's say you make 250k*6 years + 1 M*34 years = $35.5 M. 1M average is on the low side to take into account recessions and mistakes, which will occur. Keep in mind that during the initial period, you will be working >100 hours a week to be very competitive in high finance. Is the extra money worth it?

However, I'm still risk averse. if my goal is to optimize b/w maximizing payout and minimizing risk, is ROAD still worthwhile? I can't defer the job to do a year of internship.

Personally, I don't see how anyone who is risk-averse would make such bold bets in high finance. It's exciting and engaging, but it's still just fancy gambling. Even the prodigies in high finance with immeasurably high IQs are not consistent in their performance. I remember Buffett discussing how the two recent Nobel Laureates in econ made this highly calculated and nuanced model that ended up failing abysmally...leading to financial suicide for both. ROAD offers you the stability you need...it's not like you can't make the same investments with your ROAD money. The difference is the hospital won't fire you because your portfolio wasn't differentiated enough and crashed.

 

[Chakrabs]

Let me get this straight: around your third year, you started disliking medicine and then you started "following and studying finance". And out of the blue you were offered a private equity job with a starting salary of 250k? I find this incredibly hard to believe. You didnt mention that you had any previous working experience or background in finance. I know plenty of people in finance, all graduating from top schools and have been working for a while. None of them are pulling in that much without an MBA.

Also, do you have an understanding of the time and hours you must put in to make the kind of money you apparently are interested in? It makes residency look like a cakewalk, and often involves plenty of paperwork and drudgery in front of spreadsheets. Furthermore, as a poster above mentioned, it offers none of the relative job security physicians enjoy. Frankly, if I were you, I'd do the ROAD residency, and then look at starting up a for-profit clinic or other medical business if you felt like it.

 

[Law2Doc]

...which is why you switched "law2doc".

Um no. Many of the nontrads are doing this at a big financial loss because we happen to prioritize professional satisfaction over money. Something you clearly don't get yet based on your post. But you hopefully will after a few years down the rabbit hole. Good luck with that.

 

[Oxer45]

Let me get this straight: around your third year, you started disliking medicine and then you started "following and studying finance". And out of the blue you were offered a private equity job with a starting salary of 250k? I find this incredibly hard to believe. You didnt mention that you had any previous working experience or background in finance. I know plenty of people in finance, all graduating from top schools and have been working for a while. None of them are pulling in that much without an MBA.

Also, do you have an understanding of the time and hours you must put in to make the kind of money you apparently are interested in? It makes residency look like a cakewalk, and often involves plenty of paperwork and drudgery in front of spreadsheets. Furthermore, as a poster above mentioned, it offers none of the relative job security physicians enjoy. Frankly, if I were you, I'd do the ROAD residency, and then look at starting up a for-profit clinic or other medical business if you felt like it.

I gotta agree. I have friends who are I-bankers. After 2-3 yrs, you are expected to get an MBA then move up to a VP position. The interesting thing is about 50% of people don't return to banking after getting their MBA. Also they typical working week for bankers is 100hrs/wk and as a junior banker its usually in front of a computer not clients. There are no national work hour rules for bankers. Also the job security sucks.

Also no private equity will offer someone a job, let alone 250k one in this economy without any experience. Starting salary for junior banker is around 100k and bonus brings around 50k these days. VP salary starts at 250k. Also key to getting an i-banking job is prior internship, which you don't have.

Factual errors in your OP leads me to believe you are a troll.

 

[WACC]

Um no. Many of the nontrads are doing this at a big financial loss because we happen to prioritize professional satisfaction over money. Something you clearly don't get yet based on your post. But you hopefully will after a few years down the rabbit hole. Good luck with that.

You're hilarious man. Clearly you enjoy the professional satisfaction of medicine enough to take the time to make 24k posts on SDN. Let's be honest, I think you're just a risk averse cat who became a lawyer, then you saw law bottoming out or realized you wouldn't make the cull to partner, and so you ran away to medicine.

 

[WACC]

I had a similar existential crisis, only earlier in med school, mainly due to the lack of emphasis on problem solving (as you mentioned). Ultimately, I decided ROAD was the better path. Let's do the math here...

Not sure which field you're talking about, but none of the ROAD specialties average 400-600k anymore, including rads (the most highly compensated on avg), and definitely will not for the rest of your life.

But for argument's sake, let's assume you average 600k for life. I'll assume you're going into rads and graduate fellowship at 31. 50k*6 years + 600k*34 year career = $20.7 M.

For PE, you start at 250k. So let's say you make 250k*6 years + 1 M*34 years = $35.5 M. 1M average is on the low side to take into account recessions and mistakes, which will occur. Keep in mind that during the initial period, you will be working >100 hours a week to be very competitive in high finance. Is the extra money worth it?

Personally, I don't see how anyone who is risk-averse would make such bold bets in high finance. It's exciting and engaging, but it's still just fancy gambling. Even the prodigies in high finance with immeasurably high IQs are not consistent in their performance. I remember Buffett discussing how the two recent Nobel Laureates in econ made this highly calculated and nuanced model that ended up failing abysmally...leading to financial suicide for both. ROAD offers you the stability you need...it's not like you can't make the same investments with your ROAD money. The difference is the hospital won't fire you because your portfolio wasn't differentiated enough and crashed.

It's hard to assign a precise valuation to either track because of the uncertainty. You think 400-600 in ROAD will fade, let's suppose it will still exist in PP in a non coastal city. The 1mm/yr you project out is not that straightforward. The standard culls in the firm I was offered at seem to be in yrs 3 and 6. The general partners are worth in the high 8s, so if I can make it past the culls (again, highly competitive) I'm set. If I don't, there will be other bids for me elsewhere depending on the economy, my track record, etc

Perhaps risk averse isn't the right phrase....I'm risk aware and aware of the "fat tails" that could get me culled or see bids disappear. Just as a side note, in PE I'll be making investments with others' money, not my own. in ROAD I'd likely just end up making half assed bets in public equities if I were to "invest". Medicine alone even ROAD doesn't allow for the kind of wealth accumulation you'd need to make the equity investments necessary to control companies other than small businesses. By the way, Buffet's criticism of quantitative investing is interesting as well...I don't necessarily agree with his criticism and think the founders of LTCM were actually well aware of the limits of their style of investing. They were simply incentivized not to control their risk because most of the money they were betting with was not their own. That said, PE is closer to what Buffet does than what Robert Merton did.

 

[Medstudentquest]

It's hard to assign a precise valuation to either track because of the uncertainty. You think 400-600 in ROAD will fade, let's suppose it will still exist in PP in a non coastal city. The 1mm/yr you project out is not that straightforward. The standard culls in the firm I was offered at seem to be in yrs 3 and 6. The general partners are worth in the high 8s, so if I can make it past the culls (again, highly competitive) I'm set. If I don't, there will be other bids for me elsewhere depending on the economy, my track record, etc

Perhaps risk averse isn't the right phrase....I'm risk aware and aware of the "fat tails" that could get me culled or see bids disappear. Just as a side note, in PE I'll be making investments with others' money, not my own. in ROAD I'd likely just end up making half assed bets in public equities if I were to "invest". Medicine alone even ROAD doesn't allow for the kind of wealth accumulation you'd need to make the equity investments necessary to control companies other than small businesses. By the way, Buffet's criticism of quantitative investing is interesting as well...I don't necessarily agree with his criticism and think the founders of LTCM were actually well aware of the limits of their style of investing. They were simply incentivized not to control their risk because most of the money they were betting with was not their own. That said, PE is closer to what Buffet does than what Robert Merton did.

Not to be rude here, why would would an equity firm offer someone like you, with no experience/MBA, etc 250k off the bat? I know a good group of Ivy league educated, MBA having people with great pedigrees and experience and most of them are not pulling that kind of money and some have been working a good # of years. What makes you so special? Also, which ROAD specialty did you match in? I'm not sure any of the ROAD specialties make in the 600k range, certainly not to start.

 

[WACC]

I had a similar existential crisis, only earlier in med school, mainly due to the lack of emphasis on problem solving (as you mentioned). Ultimately, I decided ROAD was the better path. Let's do the math here...

Not sure which field you're talking about, but none of the ROAD specialties average 400-600k anymore, including rads (the most highly compensated on avg), and definitely will not for the rest of your life.

But for argument's sake, let's assume you average 600k for life. I'll assume you're going into rads and graduate fellowship at 31. 50k*6 years + 600k*34 year career = $20.7 M.

For PE, you start at 250k. So let's say you make 250k*6 years + 1 M*34 years = $35.5 M. 1M average is on the low side to take into account recessions and mistakes, which will occur. Keep in mind that during the initial period, you will be working >100 hours a week to be very competitive in high finance. Is the extra money worth it?



Personally, I don't see how anyone who is risk-averse would make such bold bets in high finance. It's exciting and engaging, but it's still just fancy gambling. Even the prodigies in high finance with immeasurably high IQs are not consistent in their performance. I remember Buffett discussing how the two recent Nobel Laureates in econ made this highly calculated and nuanced model that ended up failing abysmally...leading to financial suicide for both. ROAD offers you the stability you need...it's not like you can't make the same investments with your ROAD money. The difference is the hospital won't fire you because your portfolio wasn't differentiated enough and crashed.

Not to be rude here, why would would an equity firm offer someone like you, with no experience/MBA, etc 250k off the bat? I know a good group of Ivy league educated, MBA having people with great pedigrees and experience and most of them are not pulling that kind of money and some have been working a good # of years. What makes you so special? Also, which ROAD specialty did you match in? I'm not sure any of the ROAD specialties make in the 600k range, certainly not to start.

The short answer is, because I went after it. Also, I have a pretty good resume. Edit. actually, it's a pretty baller resume, excepting my med school grades.

 

[Chakrabs]

The short answer is, because I went after it. Also, I have a pretty good resume. Edit. actually, it's a pretty baller resume, excepting my med school grades.

So you say, yet make no mention of it as you solicit advice. And you follow that up by mocking commentators. So, I'm just going to say its all bull****. Do whatever floats your boat, buddy.

 

[WACC]

So you say, yet make no mention of it as you solicit advice. And you follow that up by mocking commentators. So, I'm just going to say its all bull****. Do whatever floats your boat, buddy.

Anyone else besides mlw or dumb with worthwhile insight or comments?

 

[Dr. USMLE]

Perhaps risk averse isn't the right phrase....I'm risk aware and aware of the "fat tails" that could get me culled or see bids disappear. Just as a side note, in PE I'll be making investments with others' money, not my own. in ROAD I'd likely just end up making half assed bets in public equities if I were to "invest". Medicine alone even ROAD doesn't allow for the kind of wealth accumulation you'd need to make the equity investments necessary to control companies other than small businesses. By the way, Buffet's criticism of quantitative investing is interesting as well...I don't necessarily agree with his criticism and think the founders of LTCM were actually well aware of the limits of their style of investing. They were simply incentivized not to control their risk because most of the money they were betting with was not their own. That said, PE is closer to what Buffet does than what Robert Merton did.

You seem to have a lot of things mixed in here but let's just drill down to what matters. It seems that, like me, the bottom line for you is the reward to risk ratio. Let's try to quantify this meaningfully...

ROAD non-coastal pp reward: top 1%
PE reward: top 0.5%

ROAD risk: 1-2 on a scale of 10
PE risk: 9-10 out of 10

ROAD ratio: 99/1.5
PE ratio: 99.5/9.5

 

[WACC]

You seem to have a lot of things mixed in here but let's just drill down to what matters. It seems that, like me, the bottom line for you is the reward to risk ratio. Let's try to quantify this meaningfully...

ROAD non-coastal pp reward: top 1%
PE reward: top 0.5%

ROAD risk: 1-2 on a scale of 10
PE risk: 9-10 out of 10

ROAD ratio: 99/1.5
PE ratio: 99.5/9.5

I like the way you think. It's like a Sharpe ratio. Reward to risk is a good start, some people use reward to effort but I only care about risk, not effort.

I don't the PE risk is that high. Being an entrepreneur is 9 or 10, or entertainment is 9 or 10 and winner take all. PE is high, I just don't know how high. All due respect, SDN is not the right place to discuss this number. Any thoughts on the second issue on my OP; how to deal with the PDs and is there any hedge that exists?

 

[gutonc]

Anyone else besides mlw or dumb with worthwhile insight or comments?

You're kind of a douche. And probably a troll.

Also, you've made your choice, run with it. If you leave medicine now, your chances of getting back in in 3-5 years border on nil. If you want it as a backup, at least complete your TY.

 

[Dr. USMLE]

I like the way you think. Reward to risk is a good start, some people use reward to effort but I only care about risk, not effort.

I don't the PE risk is that high. Being an entrepreneur is 9 or 10, or entertainment is 9 or 10 and winner take all. PE is high, I just don't know how high. All due respect, SDN is not the right place to discuss this number. Any thoughts on the second issue on my OP; how to deal with the PDs and is there any hedge that exists?

That's the thing...the risk I indicated represents my thoughts on the second issue. There is no way to hedge with the PDs...their bottom line is either you attend or you don't. If you don't, you're increasing their risk, which they will be happy to magnify and displace back onto you. If you quit, you will likely never again be admitted to a ROAD specialty.

 

[WACC]

You're kind of a douche. And probably a troll.

Also, you've made your choice, run with it. If you leave medicine now, your chances of getting back in in 3-5 years border on nil. If you want it as a backup, at least complete your TY.

Anyone else besides mlw or dumb with insight?

 

[WACC]

That's the thing...the risk I indicated represents my thoughts on the second issue. There is no way to hedge with the PDs...their bottom line is either you attend or you don't. If you don't, you're increasing their risk, which they will be happy to magnify and displace back onto you. If you quit, you will likely never again be admitted to a ROAD specialty.

What do you mean by "magnify and displace"? Are they going to screw me over with ROAD or all residencies in general? Can I still get an IM Residency somewhere if I decide to come back?

 

[HondoCrouch]

Anyone else besides mlw or dumb with worthwhile insight or comments?

Of your stated options, medicine is clearly the winner.

Let's assume you're going into radiology. I am also a radiologist with a background in finance. I'm not going to go into specifics here, but the numbers you quoted are not unreasonable and are indeed within the average. Hell even if our reimbursement got cut in half many private practice rads would still be in that range. You're basically guaranteed this now.

On the other hand, as a student of the business world, you probably realize that maybe 1 in 20 will ever hit that salary range, and even for those that do, it is unlikely that it will last for their entire working careers. Yes, there is also the chance that you score big, but thats a gamble.

As it stands now youre basically guaranteed to be in the top 1% of wage earners with extremely high job security and you are trying to decide if you should throw it away for a small chance to be in the top 0.5%. Seems like a no-brainer.

 

[WACC]

Of your stated options, medicine is clearly the winner.

Let's assume you're going into radiology. I am also a radiologist with a background in finance. I'm not going to go into specifics here, but the numbers you quoted are not unreasonable and are indeed within the average. Hell even if our reimbursement got cut in half many private practice rads would still be in that range. You're basically guaranteed this now.

On the other hand, as a student of the business world, you probably realize that maybe 1 in 20 will ever hit that salary range, and even for those that do, it is unlikely that it will last for their entire working careers. Yes, there is also the chance that you score big, but thats a gamble.

As it stands now youre basically guaranteed to be in the top 1% of wage earners with extremely high job security and you are trying to decide if you should throw it away for a small chance to be in the top 0.5%. Seems like a no-brainer.

Medicine is not clearly the winner. I havent divulged the full extent of my background and network and I don't plan to, but there are a lot of doctors who have been successful on Wall St and many many more trying to get in. These neurosurgeons, radiologists, etc wouldn't be trying to break in if their careers were that clearly superior. Look up the theory of revealed preferences.

I think the numbers I'm Referencing and you are banking on for ROAD will persist. I don't think the payoff in medicine however correlates to how good you are. A 4.0 from Caltech who graduates HMS theoretically makes the same as the guy who scraped into a Caribbean MD and Bottom of the barrel residency, no? Wall St does, I just don't know whether it's worth taking that risk of finding out whether I'm good enough.

 

[Law2Doc]

You're hilarious man. Clearly you enjoy the professional satisfaction of medicine enough to take the time to make 24k posts on SDN. Let's be honest, I think you're just a risk averse cat who became a lawyer, then you saw law bottoming out or realized you wouldn't make the cull to partner, and so you ran away to medicine.

Sorry dude, not even close. Got out of law well before it bottomed out, probably the opposite of risk averse given the salary I gave up. Very myopic viewpoints and lack of insight won't serve you well in life. But hey, anyone dumb enough to finish med school only to pine over some sucker bet private equity job (translation -- cold calling salesman job) wasn't going to go that far anyhow. Good luck with that, sounds like you are making the decision that's best for the medical profession.

I pegged you as a undergrad mentality in my first post in this thread, maybe a preallo troll, and I think your responses perhaps reinforce that. FWIW the better trolls make it past 10 posts before being outed. This is purely amateur hour.

 

[Dr. USMLE]

Medicine is not clearly the winner. I havent divulged the full extent of my background and network and I don't plan to, but there are a lot of doctors who have been successful on Wall St and many many more trying to get in. These neurosurgeons, radiologists, etc wouldn't be trying to break in if their careers were that clearly superior. Look up the theory of revealed preferences.

I gave you the benefit of the doubt, but am starting to agree with the other posters. What exactly is the point of refuting calculated advice with "you don't know me and I refuse to tell you (despite creating a separate account to remain completely anonymous)?"

HondoCrouch is correct...medicine is the clear decision based on reward and risk. Doctors get into finance to properly invest their large net worth and differentiate themselves, not to jump ship on their existing, top 1% careers.

 

[WACC]

Sorry dude, not even close. Got out of law well before it bottomed out, probably the opposite of risk averse given the salary I gave up. Very myopic viewpoints and lack of insight won't serve you well in life. But hey, anyone dumb enough to finish med school only to pine over some sucker bet private equity job (translation -- cold calling salesman job) wasn't going to go that far anyhow. Good luck with that, sounds like you are making the decision that's best for the medical profession.

I pegged you as a undergrad mentality in my first post in this thread, maybe a preallo troll, and I think your responses perhaps reinforce that. FWIW the better trolls make it past 10 posts before being outed. This is purely amateur hour.

Wow you sound pretty bothered man. Don't know what got under your skin. Guess those 7 years of JD MD not only left you poorer, it made you a hell more passive aggressive than you already...."The only ones who think this way are undergrads trying to talk themselves into a medical career. "

 

[WACC]

I gave you the benefit of the doubt, but am starting to agree with the other posters. What exactly is the point of refuting calculated advice with "you don't know me and I refuse to tell you (despite creating a separate account to remain completely anonymous)?"

HondoCrouch is correct...medicine is the clear decision based on reward and risk. Doctors get into finance to properly invest their large net worth and differentiate themselves, not to jump ship on their existing, top 1% careers.

All due respect, I think you're partially talking your own book because that's the decision you made. You seem like a smart guy, but doctors who diddle in finance are not my reference point...The Michael Burry's and Robert glassman's of the world made finance a FT pursuit before they were successful, and they destroy practicing physicians in accumulated wealth.

 

[coldweatherblue]

dude, you're obviously #1 stunna. for all of our sakes, leave medicine.

 

[Law2Doc]

Wow you sound pretty bothered man. Don't know what got under your skin. Guess those 7 years of JD MD not only left you poorer, it made you a hell more passive aggressive than you already...."The only ones who think this way are undergrads trying to talk themselves into a medical career. "

Spin it how you want, you didn't even make it to 10 posts before people shouted troll. The better trolls do.

 

[gutonc]

Anyone else besides mlw or dumb with insight?

That had crazy insight. Just because I called you out on being a troll and a douche doesn't make it any less insightful. Perhaps moreso.

 

[HondoCrouch]

but there are a lot of doctors who have been successful on Wall St and many many more trying to get in. These neurosurgeons, radiologists, etc wouldn't be trying to break in if their careers were that clearly superior.

Oh, for a second there it seemed you were seeking an objective measure of the relative risk and reward for the career options you have, all of the data for which is readily available.

But since we are dealing with anectdotal evidence, there are more doctors (or anything for that matter) that have failed on Wall St than have been successes.

I gave the premise of your post the benefit of the doubt, unlikely though it is, but with every post your story seems less and less likely. Perhaps you just dont come across well on the internet, but your tone and sentence structure dont suggest such a remarkable individual as to find themselves in such a predicament unless you are riding daddy's coat tails.

 

[Radonkulous]

Let's not forget guys, WACC is a special kid. He's got "connections."

 

[notdeadyet]

Let me see if I have this straight: a not-yet-graduated medical student with no experience as a doctor and a proven affinity for contracts violation is offered a $250,000 job in healthcare private equity that he needs to run by an anonymous web forum? Why oh why do I smell troll?

 

[NotAProgDirector]

I too am having some trouble understanding the math here.

Doing the ROAD seems like the safer route. If you start your ROAD training, you're very likely to finish. Very few people fail out. Once you finish training, you're "guaranteed" to make the $600K salary. It's essentially recession proof, and very stable.

Doing PE seems like the more dangerous route, but can have the bigger payout. You seem to suggest that there's no chance of "failing" at PE, and honestly I don't really know, but it seems to me that's not accurate. If you "fail" at a PE firm (i.e. get "culled" per your terms), it's not so clear that some other firm will just pick you up. So, if successful at PE, you get the really big payday. If you fail at PE, you get zero.

I can tell you that if you renege on your match, you will likely never get a residency spot again. First, you'll be absolutely barred from the match for at least 5 years, and perhaps forever. Since the match is now "all-in", that will be the end. In addition, programs will be less than likely to take a risk on someone who "bailed out" once -- I'd be worried that you'd start and then quit. And, after a few years your skills will clearly be rusty and there is no way to improve them (you can't get medical experience outside of a medical school or training program). And, even if you did get into an IM program, there's no way you'd be making the $600K listed above.

So, it seems to me that it's the "safe" option of ROAD, or the "risk" of PE with a bigger payout at a higher risk. If there is no higher risk to the PE option, then simply choose what you want to do -- both make a great salary and you should do what you enjoy.

 

[colbgw02]

Let me see if I have this straight: a not-yet-graduated medical student with no experience as a doctor and a proven affinity for contracts violation is offered a $250,000 job in healthcare private equity that he needs to run by an anonymous web forum? Why oh why do I smell troll?

Meh...

 

[Andreji]

"That guy negotiated a merger with Mom, but died from boneitis before being able to close the deal. He was apparently too busy being a "go-go 80s business man" to remember to find a cure."

 

[WACC]

I too am having some trouble understanding the math here.

Doing the ROAD seems like the safer route. If you start your ROAD training, you're very likely to finish. Very few people fail out. Once you finish training, you're "guaranteed" to make the $600K salary. It's essentially recession proof, and very stable.

Doing PE seems like the more dangerous route, but can have the bigger payout. You seem to suggest that there's no chance of "failing" at PE, and honestly I don't really know, but it seems to me that's not accurate. If you "fail" at a PE firm (i.e. get "culled" per your terms), it's not so clear that some other firm will just pick you up. So, if successful at PE, you get the really big payday. If you fail at PE, you get zero.

I can tell you that if you renege on your match, you will likely never get a residency spot again. First, you'll be absolutely barred from the match for at least 5 years, and perhaps forever. Since the match is now "all-in", that will be the end. In addition, programs will be less than likely to take a risk on someone who "bailed out" once -- I'd be worried that you'd start and then quit. And, after a few years your skills will clearly be rusty and there is no way to improve them (you can't get medical experience outside of a medical school or training program). And, even if you did get into an IM program, there's no way you'd be making the $600K listed above.

So, it seems to me that it's the "safe" option of ROAD, or the "risk" of PE with a bigger payout at a higher risk. If there is no higher risk to the PE option, then simply choose what you want to do -- both make a great salary and you should do what you enjoy.

I think I made clear there was a chance of not making it in PE...otherwise I wouldn't have started this discussion. Just to be clear, I'm commingling risk of keeping the position with the risk of the firm blowing up as the two are correlated.

not having the backup can be good in a way...it certainly lights a fire under one's self to do well. However, it doesn't sound like you're that clear on how long I'd be barred from the match. I read a sample match violation case on the NRMP website where someone actively lied about their credentials to a matched program, and was suspended for a couple of years but not five I believe. I thought reneging on a match would at the worst, get something comparable. Thoughts?

 

[WACC]

Oh, for a second there it seemed you were seeking an objective measure of the relative risk and reward for the career options you have, all of the data for which is readily available.

But since we are dealing with anectdotal evidence, there are more doctors (or anything for that matter) that have failed on Wall St than have been successes.

I gave the premise of your post the benefit of the doubt, unlikely though it is, but with every post your story seems less and less likely. Perhaps you just dont come across well on the internet, but your tone and sentence structure dont suggest such a remarkable individual as to find themselves in such a predicament unless you are riding daddy's coat tails.

I'm afraid I'm just a kid raised in a small town in the Midwest. But you've got me curious Hondo, just what is your background in finance.

 

[Medstudentquest]

The short answer is, because I went after it. Also, I have a pretty good resume. Edit. actually, it's a pretty baller resume, excepting my med school grades.

You went after what exactly? What kind of baller resume do you have with an upcoming MD, no MBA and an undergrad? Not trying to be sarcastic here, but seriously asking. Sure you may have studied and are probably an intelligent person, but what makes you so special is basically what I'm asking.

 

[Medstudentquest]

I gave you the benefit of the doubt, but am starting to agree with the other posters. What exactly is the point of refuting calculated advice with "you don't know me and I refuse to tell you (despite creating a separate account to remain completely anonymous)?"

HondoCrouch is correct...medicine is the clear decision based on reward and risk. Doctors get into finance to properly invest their large net worth and differentiate themselves, not to jump ship on their existing, top 1% careers.

Agreed. There is no point in asking such a loaded question without divulging more info. Even if OP has a good understanding of finance and even a pedigree MD/education in general, without MBA, connections, or some combination of sorts, there likely isn't anything that's so special about him. There are tons and tons of people clawing their eyes out to get those types of positions. If OP said healthcare consulting, sure you can get that right out of med school, but again unlikely at 250k off the bat. Agree that medicine is the clear winner. Like HondoCrouch said, it's likely that OP will have a stable high paying job in medicine, vs a lot of risk in business/finance/whatever. Heck, even I have a few businesses that provide sufficient money for me to retire from medicine if I wanted to currently, but have no idea if they will continue to provide in the future, so no point in not practicing medicine. It's risky to leave medicine. Also, once you leave medicine, it's likely that OP will never be able to get back , especially in ROAD specialties.

 

[WACC]

You went after what exactly? What kind of baller resume do you have with an upcoming MD, no MBA and an undergrad? Not trying to be sarcastic here, but seriously asking. Sure you may have studied and are probably an intelligent person, but what makes you so special is basically what I'm asking.

PE, good sir.

Alrite dude, you want to know? Here's how. I f***ing worked my ass off and learned everything an IBD BB analyst learns. I built out merger and LBO models on weekends and evenings. After I finished rounds and work, I crammed in equity research reports on every relevant HC company. I used med school scholarship money to take Training The Street. While other med school cats cried and moaned about "working too hard" and ducked out to chill at home every chance they could find in this bull**** of a year called MS IV year, I spammed every PE recruiter I could find, and every MM Health care PE fund in this country and then some. Finally one medical doctor who turned his back on this s****y field took a chance on me. And when I got my interviews, I killed them. And as I said, I have a pretty baller resume.. That's how, dude.

 

[dpmd]

Match violation is considered a big thing, which is why the NRMP lets you know there will be consequences. According to their site:
"In addition, the applicant may be barred from subsequent NRMP matches and/or identified as a match violator to participating programs for a period of one to three years or permanently, as determined by the NRMP."

I find it hard to believe that if you don't take this job now that you would not be able to get a similar job in a year or so. That would suggest to me that the long term prospects in that career would not be very good and should factor in to the decision. If it would be possible to get a similar job later, then it seems like the best way to hedge your bets would be to start residency (and perhaps discover that the things you dislike about medicine don't necessarily apply to residency and eventual practice). If you still hate it, you could apply for a finance job without having to be a contract violator.

 

[WACC]

Match violation is considered a big thing, which is why the NRMP lets you know there will be consequences. According to their site:
"In addition, the applicant may be barred from subsequent NRMP matches and/or identified as a match violator to participating programs for a period of one to three years or permanently, as determined by the NRMP."

I find it hard to believe that if you don't take this job now that you would not be able to get a similar job in a year or so. That would suggest to me that the long term prospects in that career would not be very good and should factor in to the decision. If it would be possible to get a similar job later, then it seems like the best way to hedge your bets would be to start residency (and perhaps discover that the things you dislike about medicine don't necessarily apply to residency and eventual practice). If you still hate it, you could apply for a finance job without having to be a contract violator.

LT, as best I understand, are to either stay in PE and win the lottery, or move to something w/ a minimum payout, ceteris paribus, on the low end of the range between primary care and ROAD.

I appreciate your thoughts. Thanks. The reason I want to take this job now is that it's hard to come by...as one poster above alluded to...people do IBD and McK to get this sort of job. Also, the doctor that ended up being my advocate really put himself on the line to get me an offer. I feel worse about burning him than a residency program that at the end of the day sees me as an interchangeable commodity and pays me a lot less for that privilege too. Good night.

 

[Medstudentquest]

LT, as best I understand, are to either stay in PE and win the lottery, or move to something w/ a minimum payout, ceteris paribus, on the low end of the range between primary care and ROAD.

I appreciate your thoughts. Thanks. The reason I want to take this job now is that it's hard to come by...as one poster above alluded to...people do IBD and McK to get this sort of job. Also, the doctor that ended up being my advocate really put himself on the line to get me an offer. I feel worse about burning him than a residency program that at the end of the day sees me as an interchangeable commodity and pays me a lot less for that privilege too. Good night.

Because very few of the ROAD specialties pay what you are suggesting. Ophtho is in the dumps, as well as gas, Derm is heading that way and doesn't generally pay what you suggest either. If you are suggesting you matched into something like Ortho/Uro it's possible you'd make that but they are not ROAD specialties really. So instead of trying to make this so mysterious it's better to divulge certain things to sound like you really do have a question vs just trying to troll. Just my 2 cents.

 

[dragonfly99]

I think you should do the private equity thing because you are not really interested in medicine any more. It's too hard of a job to do something that you don't like...not saying you won't work as hard or harder in finance, but you're obviously more interested in it if you were willing to put in all those hours making spreadsheets, etc. I agree you won't get back into radiology if you bail on your match. If you wanted to hedge you would do at least an intern year and probably a whole residency before bailing out. However, I am not qualified to say whether this private equity type job would be easier or harder to get after doing a residency, either...in general doctors who are fully trained have more value, but that might not be true in all business/finance fields.

 

[mlw03]

This got a lot more interesting since I last posted. Not sure what the discussion is ongoing for at this point, other than people calling each other names. If you want to do the business thing, do it and move on. But recognize that if you don't like it or if it doesn't work out, you will likely not be able to obtain a residency position, whether it's because of your match violation status or because you'll be unable to find a program director willing to take someone who has, through their actions, shown that they are not committed to medicine long-term.

 

[bcat85]

This got a lot more interesting since I last posted. Not sure what the discussion is ongoing for at this point, other than people calling each other names. If you want to do the business thing, do it and move on. But recognize that if you don't like it or if it doesn't work out, you will likely not be able to obtain a residency position, whether it's because of your match violation status or because you'll be unable to find a program director willing to take someone who has, through their actions, shown that they are not committed to medicine long-term.

I second this. If you want to do finance, by all means... go for it. But go for it with the understanding that you will be unlikely to get back into medicine for at least a few years, and you could potentially be banned permanently.

 

[WACC]

This got a lot more interesting since I last posted. Not sure what the discussion is ongoing for at this point, other than people calling each other names. If you want to do the business thing, do it and move on. But recognize that if you don't like it or if it doesn't work out, you will likely not be able to obtain a residency position, whether it's because of your match violation status or because you'll be unable to find a program director willing to take someone who has, through their actions, shown that they are not committed to medicine long-term.

The discussion is in my OP and is, 1) what issues should I be thinking about in valuing a ROAD career, and 2) what are the exact consequences to reneging on a match. Only a few posters have contributed any meaningful insight, and no one seems to know an exact number for 2, including you and some self proclaimed PD, and instead toss around vague generalities. I find it hard to believe there are residencies that would take IMGs who are 6 to 10 years out of med school with low boards after practicing third world medicine and not AMGs w good boards who decided to give medicine another shot, after working 100 hr weeks in one of the most competitive fields on earth.

 

[Substance]

Nice discussion.

My advice is to finish your ROAD residency and then do PE.

If you're keen on investing you've probably read Benjamin Graham's books. He always advocated having a margin of safety and a backup plan - something consistently generating cash in times of crisis. Your ROAD training will act as that margin of safety.

Here's how it goes:

1. Finish ROAD.
2. Go into PE. The next step determines whether or not you stay in PE:
3a. You make millions in PE and never look back.
3b. You fail at PE but fall back on your 400k ROAD career.

Keep in mind that your 400k ROAD career will always provide consistent capital for re-investment. What other investment has such great, guaranteed returns?

 

[WACC]

I second this. If you want to do finance, by all means... go for it. But go for it with the understanding that you will be unlikely to get back into medicine for at least a few years, and you could potentially be banned permanently.

You are a medical student. You know as little about the consequences of match violation as I do. Please shut up. Thanks.

 

[Substance]

The discussion is in my OP and is, 1) what issues should I be thinking about in valuing a ROAD career, and 2) what are the exact consequences to reneging on a match. Only a few posters have contributed any meaningful insight, and no one seems to know an exact number for 2, including you and some self proclaimed PD, and instead toss around vague generalities. I find it hard to believe there are residencies that would take IMGs who are 6 to 10 years out of med school with low boards after practicing third world medicine and not AMGs w good boards who decided to give medicine another shot, after working 100 hr weeks in one of the most competitive fields on earth.

I see what you're saying.

Keep this in mind though: The programs that take the third-world applicants are usually malignant crap-ass community programs, not much better than third-world programs, that need warm bodies who won't complain. The FMGs fill that role nicely. They'll probably take you if you apply, being a ROAD-ready AMG, but don't expect to be happy with your choice.

The ROAD programs that you are currently a contender for will have a hard time taking you later for two reasons: you left once before, and there are new fresh medical graduates competing with you. It's like going into the ring again with opponents you cannot measure, and there are no guarantees the second time around.

I have no idea how the match works, so I can't really comment on whether leaving is a match violation or not. The match is a ******ed system anyway, so there's that.